Mechanical ventilation in patients with cardiogenic pulmonary edema: a sub-analysis of the LUNG SAFE study
Laura Amado‐Rodríguez, Raquel Rodríguez-García, Giacomo Bellani, Tài Pham, Eddy Fan, Fabiana Madotto, John G. Laffey, Guillermo M. Albaiceta, LUNG SAFE investigators, Antonio Pesenti, Laurent Brochard, Andres Esteban, Luciano Gattinoni, Frank van Haren, Anders Larsson, DanielF McAuley, Marco Ranieri, Gordon D. Rubenfeld, Bruce Thompson, Hermann Wrigge, Arthur S. Slutsky, Fernando Ríos, Frank van Haren, Thierry Sottiaux, Pieter Depuydt, Fredy S Lora, Luciano César Pontes Azevedo, Guillermo Bugedo, Haibo Qiu, Marcos Gonzalez, Juan Silesky, Vladimír Černý, Jonas Nielsen, Manuel Jibaja, Hermann Wrigge, Dimitrios Matamis, Jorge Luis Ranero, Pravin Amin, Seyed Mohammad Reza Hashemian, Kevin Clarkson, Kiyoyasu Kurahashi, Asisclo Villagómez, Amine Ali Zeggwagh, Leo M. Heunks, Jon Henrik Laake, Jose Emmanuel Palo, Antero Fernandes, Dorel Săndesc, Yaasen Arabi, Vesna Bumbasierevic, Nicolás Nín, José A. Lorente, Anders Larsson, Lise Piquilloud, Fekri Abroug, DanielF McAuley, Lia McNamee, Javier Hurtado, Ednan K. Bajwa, Gabriel D’Empaire, Hektor Sula, Lordian Nunci, Alma Cani, Alan Zazu, Christian Dellera, Carolina S. Insaurralde, S. Lomas, San Isidro, Risso V Alejandro, Julio Daldin, Mauricio Vinzio, Ruben O Fernandez, Luis Pablo Cardonnet, Lisandro Roberto Bettini, Mariano Carboni Bisso, Emilio M. Osman, Mariano Setten, Pablo Lovazzano, Javier Álvarez, Veronica Villar, Norberto C. Pozo, Nicolas Grubissich, Gustavo Plotnikow, Daniela N. Vásquez, Santiago Ilutovich, Norberto Tiribelli, Ariel Chena, Carlos A. Pellegrini, María G. Sáenz, Elisa Estenssoro, Matías Brizuela, Hernan Gianinetto, Pablo E. Gomez, Valeria I. Cerrato, Marco Bezzi, Silvina Borello, Flavia A. Loiacono, Adriana Fernández, Serena Knowles, Claire Reynolds
Abstract
Abstract Background Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Methods Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model. Results From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59–78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57–77] vs 74 [64–80] years, p < 0.001) and had lower driving (12 [8–16] vs 15 [11–17] cmH 2 O, p < 0.001), plateau (20 [15–23] vs 22 [19–26] cmH 2 O, p < 0.001) and peak (21 [17–27] vs 26 [20–32] cmH 2 O, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60–1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16–2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06–1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52–0.93], p = 0.015) were related to survival. Conclusions Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury. Trial registration Clinicaltrials.gov NCT02010073